AB1698 HIGH-VELOCITY LOW-AMPLITUDE SPINAL MANIPULATIONS FOR THE MANAGEMENT OF LUMBAR RADICULAR SYNDROME: A SYSTEMATIC REVIEW WITH META-ANALYSIS
Authors: G. Bertoni, R. Serio, F. Andreoletti, F. Maselli, M. Testa, S. Battista
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Lumbosacral Radicular Syndrome (LSRS) is a condition characterised by pain radiating in one or more dermatomes (Radicular Pain) and/or the presence of neurological impairments (Radiculopathy) <sup>[1]</sup>. Physiotherapy plays a crucial role in LSRS management <sup>[2]</sup>. So far, different reviews have investigated the effect of HVLA (high-velocity low-amplitude) spinal manipulations in LSRS <sup>[3–7]</sup>. However, these studies included 'mixed' population samples (LBP patients with or without LSRS) and treatments other than HVLA spinal manipulations (e.g., mobilisation, soft tissue treatment, etc.). Hence, the efficacy of HVLAT in LSRS is yet to be fully understood. <h3>Objectives</h3> This review investigated the effect and safety of HVLATs on pain, levels of disability, and health-related quality of life in LSRS, as well as any possible adverse events. <h3>Methods</h3> A systematic review with meta-analysis. We searched Randomised Controlled Trials (RCT) published in English in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), EMBASE, PEDro and Web of Science up to June 2022. We considered eligible RCTs on an adult population (18-65 years) with LSRS that compared HVLATs with other non-surgical treatments, sham spinal manipulation, or no intervention. Two authors selected the studies, extracted the data, and assessed the methodological quality through the 'Risk of Bias (RoB) Tool 2.0' and the certainty of the evidence through the 'GRADE tool'. A meta-analysis was performed to quantify the effect of HVLA on pain levels. <h3>Results</h3> A total of 308 records were retrieved from the search strings. Only two studies met the inclusion criteria. Both studies were at high RoB. Two meta-analyses were performed for low back and leg pain levels. HVLA seemed to reduce the levels of low back (MD = -1.48; 95% CI = -2.45, -0.50) and lower limb (MD = -2.36; 95% CI = -3.28, -1.44) pain compared to other conservative treatments, at three months after treatment. However, high heterogeneity was found (<i>I² = 0.0%, p = 0.735</i>). Besides, their certainty of the evidence was 'very low'. No adverse events were reported. <h3>Conclusion</h3> In line with our results, we cannot conclude whether HVLA spinal manipulations can be helpful for the treatment of LSRS or not. Future high-quality RCTs are needed to establish the actual effect of HVLA manipulation in this disease with adequate sample size and LSRS definition. <h3>References</h3> [1]Spijker-Huiges A, Vermeulen K, Winters JC, van Wijhe M, van der Meer K. Epidural steroids for lumbosacral radicular syndrome compared to usual care: Quality of life and cost utility in general practice. <i>Arch Phys Med Rehabil</i>. 2015;96(3):381-387. doi: 10.1016/j.apmr.2014.10.017 [2]Luijsterburg PAJ, Verhagen AP, Ostelo RWJG, van Os TAG, Peul WC, Koes BW. Effectiveness of conservative treatments for the lumbosacral radicular syndrome: A systematic review. <i>European Spine Journal</i>. 2007;16(7):881-899. doi:10.1007/s00586-007-0367-1 [3]Hahne AJ, Ford JJ, Mcmeeken JM. <i>Conservative Management of Lumbar Disc Herniation with Associated Radiculopathy A Systematic Review</i>. Vol 35. [4]National Guideline Centre (Great Britain). <i>Low Back Pain and Sciatica in Over 16s: Assessment and Management</i>. National Institute for Health and Care Excellence (UK); 2016. [5]Leininger B, Bronfort G, Evans R, Reiter T. Spinal Manipulation or Mobilization for Radiculopathy: A Systematic Review. <i>Phys Med Rehabil Clin N Am</i>. 2011;22(1):105-125. doi: 10.1016/j.pmr.2010.11.002 [6]Stochkendahl MJ, Kjaer P, Hartvigsen J, et al. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. <i>European Spine Journal</i>. 2018;27(1):60-75. doi:10.1007/s00586-017-5099-2 [7]Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low-back pain. In: Assendelft WJ, ed. <i>Cochrane Database of Systematic Reviews</i>. John Wiley &amp; Sons, Ltd; 2004. doi: 10.1002/14651858.CD000447.pub2 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.